The social GP

A collaborative approach to troubled families in the Netherlands shows that local leadership can come from many levels, as Bas Denters, Pieter-Jan Klok and Mirjan Oude Vrielink explain

The city of Enschede, situated on the eastern border of the Netherlands, and three local housing associations have initiated a fresh approach to tackling problems of multiple deprivation. Known as the Social GP Programme or neighbourhood coach programme, it represents, in the Dutch context at least, a new model.

In both the Netherlands and the UK, GPs are often the ?rst point of contact for a patient requiring advice and assistance relating to their health. In simple terms, they draw on a wide general knowledge, and a variety of health service providers, to meet the needs of the patient. The idea behind the Social GP model is much the same.

Social GPs act as individual counsellors to people facing multiple or complex problems. Like their British counterparts, Dutch central and local government have been concerned about multiple deprivation for more than 20 years. In the Netherlands, as elsewhere, policies aimed at improving the life chances of households experiencing multiple problems face three major challenges:

• Many are served (or feel ‘raided’) by a small army of social professionals employed by numerous social and medical care organisations – an integrated approach is lacking
• A minority of these households slip through the net and do not receive support at a point when emerging problems are in their early stages and preventive action could avert future crisis
• The care provided by professionals can be highly paternalistic and tends to make clients dependant on professional support rather than empowering them to take decisions about their lives into their own hands.

The Social GP Programme aims to address these three related challenges. In Enschede, some 25 institutional providers of specialised services agreed to grant the Social GPs informal decision-making powers across various spheres of life – health, housing, education, safety, welfare and/or employment – while retaining the formal decision-making authority themselves.

The model is being tried out in the Velve-Lindenhof neighbourhood, with the aim of improving the life chances of over 600 people. An outreach approach has been adopted by Social GPs and through house calls they strive to make contact with all residents. It’s hoped that it will not only be possible to provide a more integrated approach to multi-problem households, but also to reach those that may be experiencing issues that can be addressed by preventive action.

What has emerged so far is an interesting mix of shared governance (by an alliance of administrative and community leaders) at the strategic level, and a form of frontline, street-level leadership by four neighbourhood coaches at the operational level. The programme started in 2009 and the results of an interim evaluation are promising.

THE ROOTS OF THE PROGRAMME
The Social GP Programme builds on the experiences of two previous initiatives designed to tackle problems experienced by residents of Velve-Lindenhof. The emphasis on outreach, aiming to detect emerging problems early on when preventive action is still possible, echoes a pilot where house calls were used as a strategy for neighbourhood regeneration.

It also draws on a scheme to improve the governance of service delivery. In 2004, Enschede and 25 service providers and local government departments signed a covenant to collaborate in neighbourhood care teams whose aim was to create more integral, efficient and effective care provision, with a focus on multi-problem families. Members of the teams acted as case managers, providing families with a single point of access. This was an improvement on previous practice, but did not change the silo-driven approach to decision-making; furthermore the 2004 system was not designed to serve a wider community, including those experiencing problems without (yet) being labelled a multi-problem family.

The covenant partners decided to draw up an addendum to include collaboration through a team of four neighbourhood coaches. At the strategic level it was agreed to endow all four coaches with informal decision-making powers across various spheres of activity, including the ability to use resources across organisational borders. They would draw up plans of action to be formalised by the back offices of the organisations bearing legal responsibility.

The strategic leadership agreed that this back-office authorisation should be a mere formality so that the coaches would have real power ‘to do business’. In addition, it was agreed to assign at least one contact in each organisation to ensure smooth authorisation and implementation of the plans.

The Social GP Programme builds on these two initiatives. From a governance perspective, the new initiative provides an interesting, innovative hybrid. On the strategic level it is based on shared governance: a coalition of 25 community and governmental organisations has voluntarily agreed an integral approach to the social emancipation of residents and multi-problem households. In order to implement this at the operational level, the four neighbourhood coaches were empowered to act decisively in pursuit of an integrated plan of action worked out in dialogue with their clients.

In Enschede the coaches are not employed by a lead organisation (such as the municipality); instead they operate from different organisations: the housing association, the organisation for general social welfare and the municipal department of social security.

THE ROLE OF LEADERSHIP
Although in a formal sense the model was based on an agreement between 25 organisations, informally a senior manager in Enschede’s social support department took the lead. He wanted to move beyond the disjointed inter-organisational model of governance and dared everyone to move outside their comfort zone. Because of this bold, persuasive approach, he was widely respected.

The national government, in its new Neighbourhood Policy Initiative, offered a window of opportunity for Enschede to push through its Social GP Programme. It was supported by the three housing associations with property in the neighbourhood, and a think tank – comprising officials from a variety of municipal departments and community organisations, as well as a number of independent experts – was established.

The ideas developed in this group were then discussed and agreed and a plan of action was developed before the programme started in 2009. The fact that the costs would be funded by a special subsidy from the three local housing associations was crucial to acceptance of the plan by participating organisations.

Normally, leadership is equated with the activities of formal leaders holding senior positions in their organisations. In this case, however, an informal alliance of managerial and community leaders at the strategic level set the stage; it is doubtful whether a purely government-directed reform process would have been successful. Sharing the initiative with various professional organisations and introducing it to an in?uential and widely respected community organisation – the Velve-Lindenhof Community Council – was important in establishing the programme’s legitimacy.

The involvement from the outset of middle managers, frontline workers and external experts from various organisations in further developing the strategy is also likely to have contributed to its successful adoption. The role of political leaders in Enschede was facilitatory (providing room for experimentation and support) rather than initiatory, and it is hard to see how the programme could have developed without this sort of political leadership.

It is important, however, to recognise that the initiative combines its strategic leadership with a model of frontline or street-level leadership at the operational level. The four neighbourhood coaches are ‘empowered to empower’. These coaches – in close consultation with individual clients – are provided with the decision-making powers necessary to develop and implement integral plans of action across various spheres of life (such as health, housing and employment) aimed at improving the life chances of their clients. They have the legitimacy and authority to span organisational boundaries.

• This is an extract from chapter four of Public Sector Innovation and Local Leadership in the UK and the Netherlands, by Robin Hambleton and Joanna Howard, with contributing authors Bas Denters, Pieter-Jan Klok (both of the Institute for Innovation and Governance Studies at the University of Twente) and Mirjan Oude Vrielink. The report, which also examines Swindon and Bristol, was published by the Joseph Rowntree Foundation in June.
• To find out more, contact Bas Denters.